Interpersonal violence, early life adversity, and suicidal behavior in hypersexual men

There are significant gaps in knowledge regarding the role of childhood adversity, interpersonal violence, and suicidal behavior in hypersexual disorder (HD). The aim of this study was to investigate interpersonal violence in hypersexual men compared with healthy volunteers and the experience of violence in relation to suicidal behavior. Methods This case–control study includes 67 male patients with HD and 40 healthy male volunteers. The Childhood Trauma Questionnaire – Short Form (CTQ-SF) and the Karolinska Interpersonal Violence Scale (KIVS) were used for assessing early life adversity and interpersonal violence in childhood and in adult life. Suicidal behavior (attempts and ideation) was assessed with the Mini-International Neuropsychiatric Interview (version 6.0) and the Montgomery–Åsberg Depression Rating Scale – Self-rating. Results Hypersexual men reported more exposure to violence in childhood and more violent behavior as adults compared with healthy volunteers. Suicide attempters (n = 8, 12%) reported higher KIVS total score, more used violence as a child, more exposure to violence as an adult as well as higher score on CTQ-SF subscale measuring sexual abuse (SA) compared with hypersexual men without suicide attempt. Discussion Hypersexuality was associated with interpersonal violence with higher total scores in patients with a history of suicide attempt. The KIVS subscale exposure to interpersonal violence as a child was validated using the CTQ-SF but can be complemented with questions focusing on SA for full assessment of early life adversity. Conclusion Childhood adversity is an important factor in HD and interpersonal violence might be related to suicidal behavior in hypersexual men

Insights gained from a systematic reanalysis of a successful model-facilitated change process in health care

Health care is a complex system with multiprofessional staff and multiple patient care pathways. Time pressure and minimal margins for error make it challenging to implement new policies or procedures, no matter how desirable. Changes in health care also requires the participation of the staff. System dynamics (SD) simulations can lead to shared systems understanding and allows for the development and testing of new scenarios in silico before implementing solutions. However, research shows that the actual implementation rate of simulations is low. This paper presents a reanalysis of a successful change project in health care combining SD principles with basic action research (AR) premises. The analysis was done by a multidisciplinary research group using qualitative methodology and identifies that a fruitful combination of AR inquiry and SD modelling potentially can improve implementation rates.publishedVersio

Combining scanning haptic microscopy and fibre optic Raman spectroscopy for tissue characterization

The tactile resonance method (TRM) and Raman spectroscopy (RS) are promising for tissue characterization in vivo. Our goal is to combine these techniques into one instrument, to use TRM for swift scanning, and RS for increasing the diagnostic power. The aim of this study was to determine the classification accuracy, using support vector machines, for measurements on porcine tissue and also produce preliminary data on human prostate tissue. This was done by developing a new experimental set-up combining micro-scale TRM—scanning haptic microscopy (SHM)—for assessing stiffness on a micro-scale, with fibre optic RS measurements for assessing biochemical content. We compared the accuracy using SHM alone versus SHM combined with RS, for different degrees of tissue homogeneity. The cross-validation classification accuracy for healthy porcine tissue types using SHM alone was 65–81%, and when RS was added it increased to 81–87%. The accuracy for healthy and cancerous human tissue was 67–70% when only SHM was used, and increased to 72–77% for the combined measurements. This shows that the potential for swift and accurate classification of healthy and cancerous prostate tissue is high. This is promising for developing a tool for probing the surgical margins during prostate cancer surgery

Solitonic approach to the dimerization problem in correlated one-dimensional systems

Using exact diagonalizations we consider self-consistently the lattice distortions in odd Peierls-Hubbard and spin-Peierls periodic rings in the adiabatic harmonic approximation. From the tails of the inherent spin soliton the dimerization d_\infty of regular even rings is found by extrapolations to infinite ring lengths. Considering a wide region of electron-electron onsite interaction values U>0 compared with the band width 4t_0 at intermediately strong electron-phonon interaction g, known relationships obtained by other methods are reproduced and/or refined within one unified approach: such as the maximum of d_\infty at U \simeq 3 t_0 for g \simeq 0.5 and its shift to zero for g \to g_c \approx 0.7. The hyperbolic tangent shape of the spin soliton is retained for any U and g <~ 0.6. In the spin-Peierls limit the d_\infty are found to be in agreement with results of DMRG computations.Comment: 4 pages, 4 figures, Physical Review B, Rapid Communications, v. 56 (1997) accepte

Porównanie występowania bakterii szpitalnej w gardle środkowym i górnych drogach oddechowych przy zastosowaniu dwóch metod pielęgnacji jamy ustnej: badania na próbie losowej

Introduction. To compare changes in oral and respiratory nosocomial colonization during the first week of mechanical ventilation in adult Neuroscience ICU patients randomized to a standard or comprehensive oral care protocol. Development of ventilator associated pneumonia (VAP) within each protocol was also investigated.Material and methods. Patients were randomized to one of two groups. The standard oral care protocol included a manual pediatric toothbrush, toothpaste, and watersoluble lubricant. The comprehensive protocol consisted of tongue scraping, an electric toothbrush with a non-foaming toothpaste, followed by a moisturizing agent. Both groups received the assigned oral care protocol twice daily, with tooth brushing lasting two minutes per occasion. Oral and sputum cultures were obtained on admission and every 48 hours while intubated.Results. Data from a total of 78 patients were analyzed. The standard protocol included 40 patients (mean age 51 ± 18 years); the comprehensive protocol 38 patients (mean age 51 ± 18 years). No significant differences in Glasgow Coma Score, diagnosis, or co-morbidities were found on admission. Oral colonization on admission was noted in 25% of patients in each protocol. There was a trend of reduced oral and respiratory nosocomial colonization among those in the comprehensive protocol but no significant differences were noted between groups. Incidence of VAP was equivalent (p=0.61) for the standard and comprehensive groups at day six.Conclusions. Use of a tongue scraper, electric toothbrush, and oral gel resulted in less oral and respiratory colonization by known nosocomial pathogens. Larger studies are necessary to further investigate comprehensive oral care. (PNN 2012;1(1):10-18)Wprowadzenie. Porównanie zmian wywołanych bakterią szpitalną w obrębie jamy ustnej i górnych dróg oddechowych podczas pierwszego tygodnia wentylowania u dorosłych pacjentów neurologicznych, przebywających na oddziale intensywnej opieki medycznej, losowo wybranych do pielęgnacji jamy ustnej w sposób standardowy lub rozszerzony. Zbadanie przypadków odrespiratorowego zapalenia płuc w obu metodach zachowania higieny jamy ustnej.Materiał i metody. Pacjenci zostali losowo przydzieleni do jednej z dwóch grup. Standardowy sposób postępowania w pielęgnacji jamy ustnej polegał na zastosowaniu tradycyjnej dziecięcej szczoteczki do zębów, pasty do zębów i rozpuszczalnego w wodzie środka nawilżającego. Metoda rozszerzona polegała na szczotkowaniu języka, z zastosowaniem elektrycznej szczoteczki do zębów niepieniącą się pastą oraz środka nawilżającego. U każdej z grup przypisaną metodę stosowano dwa razy dziennie, każdorazowo szczotkując zęby przez 2 minuty. Przy przyjęciu na oddział oraz co 48 godzin pobierano od zaintubowanych pacjentów próbki śliny i wymaz z jamy ustnej w celu zbadania kultur bakterii.Wyniki. Analizie poddano wyniki 78 pacjentów. Standardowy sposób postępowania w higienie jamy ustnej zastosowano u 40 pacjentów (średni wiek 51-18 lat), natomiast rozszerzony u 38 pacjentów (średni wiek 51-18 lat). W chwili przyjęcia na oddział nie zaobserwowano statystycznie istotnych różnic w skali śpiączki Glasgow (GlasgowComa Scale), diagnozie ani współwystępujących chorobach. Bakterie w jamie ustnej w chwili przyjęcia na oddział zaobserwowano u 25 % pacjentów w każdej z dwóch grup. Zauważono tendencję spadkową w odniesieniu do liczby szpitalnych bakterii w jamie ustnej i układzie oddechowym u pacjentów przypisanych do metody rozszerzonej, ale nie znaleziono znaczących różnic pomiędzy grupami. W szóstym dniu odsetek odrespiratorowego zapalenia płuc w obu grupach (standardowej i rozszerzonej) był taki sam (p=0,61).Wnioski. W wyniku zastosowania szczoteczki do języka, szczoteczki elektrycznej oraz żelu do higieny jamy ustnej liczba bakterii szpitalnych atakujących jamę ustną i układ oddechowy była mniejsza. Potrzebne są szersze badania w celu dalszego zbadania działania rozszerzonej metody zachowania higieny jamy ustnej. (PNN 2012;1(1):10-18

Kommunikation : En kvalitativ studie av hur det verbala samtalet under en livsmedelskontroll uppfattades av livsmedelsföretagare

Då matförgiftningarna runt om i världen stadigt ökar, har livsmedelsinspektörernas roll att kontrollera hur livsmedelsföretagen uppfyller livsmedelslagstiftningen blivit allt viktigare. År 2006 ändrades den svenska livsmedelslagstiftningen till att bli mer överensstämmande med EU:s livsmedelslagstiftning. I och med denna förändring ändrades livsmedelsinspektörernas roll till att kontrollera hur väl livsmedelsföretagens rutiner för egenkontroll uppfyller livsmedelslagstiftningen. För att kommunikationen under de kontroller som livsmedelsinspektörerna utför på livsmedelsföretagen ska kunna fungera på ett effektivt och noggrant sätt, krävs det att båda parter hjälps åt. Då forskningen inom det aktuella området idag kan ses som bristfällig, har detta legat till grund för detta examensarbetes inriktning. Syftet med detta examensarbete är att studera hur livsmedelsföretagare som inte har svenska som modersmål upplevde att kommunikationen fungerade vid den senaste kontrollen. I syftet ingick även att undersöka vad kontrollrapporterna hade för betydelse för hur livsmedelsföretagare uppfattade att kommunikationen fungerade under den senaste kontrollen. För att uppnå detta syfte utfördes fem semistrukturerade intervjuer där resultatet analyserades med hjälp av ”öppen kodning”. Resultatet från intervjuerna visade att kommunikationen vid de senaste kontrollerna uppfattades som god, även om vissa hinder uppstod. Dessa hinder bestod främst av språkliga barriärer och okunskap inom den svenska livsmedelslagstiftningen. För att säkra livsmedel ska kunna uppnås, krävs det att den goda kommunikationen under en kontroll bevaras

Kommunikation : En kvalitativ studie av hur det verbala samtalet under en livsmedelskontroll uppfattades av livsmedelsföretagare

Då matförgiftningarna runt om i världen stadigt ökar, har livsmedelsinspektörernas roll att kontrollera hur livsmedelsföretagen uppfyller livsmedelslagstiftningen blivit allt viktigare. År 2006 ändrades den svenska livsmedelslagstiftningen till att bli mer överensstämmande med EU:s livsmedelslagstiftning. I och med denna förändring ändrades livsmedelsinspektörernas roll till att kontrollera hur väl livsmedelsföretagens rutiner för egenkontroll uppfyller livsmedelslagstiftningen. För att kommunikationen under de kontroller som livsmedelsinspektörerna utför på livsmedelsföretagen ska kunna fungera på ett effektivt och noggrant sätt, krävs det att båda parter hjälps åt. Då forskningen inom det aktuella området idag kan ses som bristfällig, har detta legat till grund för detta examensarbetes inriktning. Syftet med detta examensarbete är att studera hur livsmedelsföretagare som inte har svenska som modersmål upplevde att kommunikationen fungerade vid den senaste kontrollen. I syftet ingick även att undersöka vad kontrollrapporterna hade för betydelse för hur livsmedelsföretagare uppfattade att kommunikationen fungerade under den senaste kontrollen. För att uppnå detta syfte utfördes fem semistrukturerade intervjuer där resultatet analyserades med hjälp av ”öppen kodning”. Resultatet från intervjuerna visade att kommunikationen vid de senaste kontrollerna uppfattades som god, även om vissa hinder uppstod. Dessa hinder bestod främst av språkliga barriärer och okunskap inom den svenska livsmedelslagstiftningen. För att säkra livsmedel ska kunna uppnås, krävs det att den goda kommunikationen under en kontroll bevaras

Holmstr\uf6m, P. and S. Hallberg (2010). Att hantera verklighetens komplexitet med systemt\ue4nkande och verksamhetssimulering

Att modellera dynamikenDet verkligt intressanta \ue4r att, baserat p\ue5 orsak-verkansdiagram, bygga en systemdynamisk modell. I en s\ue5dan mo- dell f\uf6ljer man utvecklingen \uf6ver tid p\ue5 t ex en klinik, en mottagning, en v\ue5rdcentral eller ett sjukhus. Till skillnad fr\ue5n enkla kalkylark \ue4r det m\uf6jligt att modellera cirkul\ue4ra samband, vilket underl\ue4ttar f\uf6rst\ue5elsen av orsaker till pro- blem i en komplex verksamhet. Man anv\ue4nder en s\ue5dan tidsindelning att varierande v\ue4rden synligg\uf6rs, som annars skulle ”drunkna” i genomsnittsber\ue4kningar \uf6ver l\ue4ngre tidsperioder.P\ue5 de f\uf6ljande sidorna ger vi ett flertal exempel p\ue5 b\ue5de simuleringar och systemt\ue4nkande fr\ue5n h\ue4lso- och sjukv\ue5r- den. I simuleringsmodellerna kan man f\uf6rst bekr\ue4fta modellens trov\ue4rdighet genom att testa om den \ue5terspeglar den nuvarande verkligheten. Man kan sedan g\ue5 vidare och prova alternativa strategier, policies, metoder etc. f\uf6r att skapa en bild av hur dessa interventioner kan t\ue4nkas p\ue5verka verksamheten i olika h\ue4nseenden.Vi skapar ett anv\ue4ndar- och beslutsfattarv\ue4nligt gr\ue4nssnitt d\ue4r det finns reglage f\uf6r variabler, tabeller f\uf6r basdata och grafer p\ue5 nyckeltal. P\ue5 s\ue5 s\ue4tt kan beslutsfattare testa och optimera policies utan att f\uf6rlora sig i modellens bak- omliggande detaljer.Vi str\ue4var ocks\ue5 efter att arbeta med en snabb och interaktiv utvecklingsmetod, som inneb\ue4r att vi f\ue5r en \uf6msesidig l\ue4rprocess d\ue4r kunden successivt f\uf6rst\ue5r modelleringsmetodiken och dess anv\ue4ndbarhet. Vi f\uf6rdjupar oss i verk- samhetens processer och f\uf6rst\ue5r dess reella behov. Arbetsg\ue5ngen kan ses som en l\ue4rcykel (PDSA: Plan-Do-Study- Act) d\ue4r testandet g\uf6rs i en simulering i l\ue4rande n\ue4tverk tillsammans med verksamhetens akt\uf6rer

Minimizing the dysfunctional interplay between activity and recovery: A grounded theory on living with fibromyalgia

The aim of this study was to generate a substantive theory, based on interviews with women with fibromyalgia, explaining how they manage their main concerns in daily life. The study has an inductive approach in line with classic grounded theory (Glaser, 1992). Twenty-three women living in the southwest region of Sweden were interviewed in-depth about their daily living with fibromyalgia and problems related to this. Probing and follow-up questions were asked by the interviewers when relevant. The interviews were transcribed verbatim and consecutively analysed in line with guidelines for grounded theory. The results showed that the main concern for women with fibromyalgia was to reach a balance in daily life. This concern was resolved by them using different strategies aimed at minimizing the dysfunctional interplay between activity and recovery (core category). This imbalance includes that the women are forcing themselves to live a fast-paced life and thereby tax or exceed their physical and psychological abilities and limits. Generally, the fibromyalgia symptoms vary and are most often unpredictable to the women. Pain and fatigue are the most prominent symptoms. However, pain-free periods occur, often related to intense engagement in some activity, relaxation or joy, but mainly the &#x201C;pain gaps&#x201D; are unpredictable. To reach a balance in daily life and manage the dysfunctional interplay between activity and recovery the women use several strategies. They are avoiding unnecessary stress, utilizing good days, paying the price for allowing oneself too much activity, planning activities in advance, distracting oneself from the pain, engaging in alleviating physical activities, and ignoring pain sensations. Distracting from the pain seems to be an especially helpful strategy as it may lead to &#x201C;pain gaps&#x201D;. This strategy, meaning to divert attention from the pain, is possible to learn, or improve, in health promoting courses based on principles of cognitive behavioural therapy (CBT). We suggest that such courses are offered in primary care for patients with fibromyalgia or other types of longstanding pain. The courses should be led by registered nurses or psychologists, who are experienced in CBT and have extensive knowledge about theories on longstanding pain, stress and coping. Such courses would increase well-being and quality of life in women suffering from fibromyalgia

A System Dynamics \u27Flight Simulator‛ for the Evaluation of Policy Interventions in Patient Pathways for Cutaneous Malignant Melanoma

A system dynamics simulation model was developed as part of building improved long-time planning and policy evaluation in the patient pathways for Cutaneous Malignant Melanoma. An “incidence generator” was used to create patient output sets dependent on different patient delays in seeking treatment. A “flight simulator” was built to test the scenarios against incidence rates, follow-up programmes etc, assessing the trajectories of healthcare costs over time. It is shown that costs escalate significantly unless patient delays addressed and follow-up programmes reviewed